Reducing Readmissions for ICU Patients on Prolonged Mechanical Ventilation Through Early Transfer to Kindred Hospitals

Lengthy stays in the ICU, often caused by prolonged mechanical ventilation (PMV), are associated with a number of adverse outcomes.  One way to mitigate these outcomes is to transfer stable patients needing mechanical ventilation to a specialized Kindred Hospital that aggressively weans patients from the ventilator. 

Prolonged Stays in the ICU Related to Mechanical Ventilation

Diagnosis-related groups (DRGs) requiring mechanical ventilation for greater than 96 hours have some of the longest inpatient lengths of stay, which have serious clinical and financial consequences.^[1]

Adverse Outcomes and Readmission Risk

Lengthy stays in the ICU are associated with serious consequences for the patient, including higher mortality and readmission risk, particularly when the ventilator dependence is related to acute respiratory failure.^2,3 An extended ICU stay is also a risk factor for post-intensive care syndrome, which includes symptoms such as ICU-acquired weakness (ICUAW), cognitive deficits, and PTSD-like recurrence of frightening memories.⁴

Studies also show that PMV leads to higher rates of ICUAW and readmission.^5,6 One study found that as many as 67% of patients on PMV developed ICUAW.⁷ Additionally, the longer the period of mechanical ventilation, the higher the risk of readmission, with 36% of patients on PMV for 28 days readmitting to the ICU.⁸

Researchers attempting to address this dilemma have found that transferring PMV patients to specialized settings that focus on ventilator weaning could be beneficial for those whose conditions are otherwise stable.^9,10

Financial Considerations

In additional to clinical consequences of prolonged ICU stays for PMV, there are significant financial considerations. The average Medicare payment per day ranges from around $3,500 to over $6,000 for the above DRGs with prolonged mechanical ventilation.¹¹ During a one-year period, the total Medicare spend alone for encounters with these DRGs amounted to $3.4 billion. Additionally, the average cost of a readmission, for which PMV patients are at significant risk, amounts to $17,700.¹²

These figures further support the need for early transfer of patients to care settings that specialize in ventilator liberation.

Clinical and Financial Outcomes at Kindred Hospitals

Kindred Hospitals provide specialized acute care and rehabilitation for medically complex patients, including those on mechanical ventilation. Our focused treatment of such patients allows us to efficiently help them recover and regain their independence. 

Data show that the average 30-day readmission and mortality rates are significantly lower for DRGs 003, 004, and 207 at Kindred than in a traditional inpatient hospital.¹³ Not represented in this graph are the levels of patient complexity with these DRGs which are far greater at Kindred.¹⁴

Beyond these outcomes, 86% of Kindred’s ventilated patients are able to reach a high level of mobility, based on the Johns Hopkins level of mobility scale.¹⁵

Additionally, Medicare spend per day is significantly lower at Kindred Hospitals than at traditional hospitals.¹⁶

Kindred Hospitals’ specialized caregivers and highly targeted programs allow them to achieve these exceptional outcomes.

Kindred Hospitals’ Specialized Care

Founded in 1985 as a hospital company dedicated to the care of ventilator patients, Kindred Hospitals has been treating serious pulmonary conditions for almost 40 years. 

Our high-level staffing allows us to accept critically ill patients on mechanical ventilation once they have reached a stable condition. Pulmonary patients benefit from:

• Physician-led interdisciplinary care
• Pulmonologist consultations
• 24/7 access to respiratory therapy
• ACLS-certified nurses in the ICU
• Low nurse-to-patient ratios in the ICU
• Physical, occupational, and speech therapy

We also have established care initiatives that promote recovery, including:

• The Move Early Program, through which we incorporate movement into care plans as soon as is safe, even for those on mechanical ventilation.
• Disease-specific care certifications in Respiratory Failure from The Joint Commission, ensuring a standardized, evidence-based approach to care and to performance measurement and improvement. 

At a Kindred Hospital, medically complex patients, including those on mechanical ventilation, benefit from highly specialized and efficient care in a facility focused specifically on their needs. With the significant clinical risks and financial considerations associated with prolonged stays in the ICU for mechanical ventilation, transferring these patients to a Kindred Hospital once they are stable is an important strategy in improving patient outcomes, and reducing readmission risk and cost.